AB0895 Residual burden and disease activity of Canadian PsA patients treated with advanced therapies: preliminary results from a multiple registry analysis (UNISON-PsA)
Authors: D. Choquette, V. Chandran, M. C. Laliberté, P. A. Fournier, T. Girard, M. Sutton, D. D. Gladman
Journal: Annals of the Rheumatic Diseases (2022)

Background Given the availability of advanced therapies in PsA with different modes of action, it is of interest to characterize their impact on overall clinical outcomes. Objectives To describe residual disease activity in Canadians with PsA treated with advanced therapies. Methods Multi-region, observational, retrospective analysis of data from Rhumadata (Quebec) and International Psoriasis and Arthritis Research Team (IPART) Canadian registries was performed. Data from each registry and region were analyzed separately using a common statistical analysis plan to generate descriptive statistics. Patients included in the registries were eligible if they were adults at the time of PsA diagnosis and were treated with an advanced therapy for ≥6 months initiated between January 2010 and December 2019. Residual disease activity was defined as failing to achieve MDA (defined as achieving ≥5 of: TJC ≤1; SJC ≤1; PASI ≤1 or BSA ≤3%; patient pain VAS score of ≤15 mm; patient global disease activity VAS score of ≤20 mm; HAQ score ≤0.5; and tender entheseal points ≤1) (primary endpoint), or DAPSA score ≥14 (secondary endpoint) within 6 months of initiation of an advanced therapy (TNFi, IL-12/23i, IL-17i, PDE4i, CTLA4i or JAKi). Results 1,866 subjects (Atlantic [IPART; Newfoundland]: N=83; Quebec [Rhumadata]: N=687; Ontario [IPART]: N=966; West [IPART; British Columbia, Manitoba]: N=130) were included in this preliminary analysis. Baseline characteristics are presented in Table 1. Overall, 899 were receiving their 1 st advanced therapy, 464 were receiving their 2 nd , and 264 had received ≥3. The most common therapy class was TNFi, followed by IL-17i. 18/21 (85.7%) subjects in the Atlantic region with an assessment, 184/246 (74.8%) in Quebec, 391/571 (68.1%) in Ontario, and 30/43 (69.8%) in Western Canada failed to achieve MDA within 6 months following advanced therapy initiation. Failure to achieve MDA within the allotted period was higher among patients receiving an IL-17i compared with a TNFi. There was no appreciable effect of lines of therapy. Also, 74 of 110 (67.3%) patients with an assessment in Quebec, 201/365 (55.1%) in Ontario and 3/3 (100%) in the West failed to achieve at least low disease activity (LDA; DAPSA ≤14) within 6 months following initiation of an advanced therapy. Data were not available for the Atlantic region. The proportion of patients not achieving LDA by advanced therapy was similar for those receiving a TNFi and IL-17i but increased with line of therapy. Table 1. Patient demographic and baseline characteristics, and response to treatment Atlantic (N=83 ) Quebec (N=687 ) Ontario (N=966 ) West (N=130 ) Age (years, mean [SD]) 50.3 (11.1) 50.7 (12.1) 49.1 (12.9) 46.7 (12.1) Female (n [%]) 44/83 (53.0) 346/687 (50.4) 427/966 (44.2) 81/128 (62.3) BMI (kg/m 2 , n, mean [SD]) 15, 30.8 (3.6) 553, 29.6 (6.6) 579, 30.6 (6.9) 45, 32.8 (10.6) Time since diagnosis (years, N, mean [SD]) 83, 8.7 (8.7) 687, 7.1 (7.9) 895, 11.7 (11.1) 74, 11.7 (8.9) HLA-B27 positive (n/N [%]) N/A 58/335 (17.3) 86/648 (13.3) N/A Presence of EAMs (n/N [%]) 4/44 (9.1) 27/687 (3.9) 65/693 (9.4) 2/33 (6.1%) Fulfillment of CASPAR (n/N [%]) N/A 391/687 (56.9) 100/100 (100) N/A Therapy class (n [%]):* TNFi 66 (79.5) 478 (69.6) 651 (67.3) 104 (80.0) IL-17i 11 (13.3) 106 (15.4) 191 (19.9) 21 (16.2) IL-12/23i 6 (7.2) 33 (4.8) 124 (12.9) 5 (3.9) PDE4i 48 (7.0) Other 22 (3.2) Failure to achieve MDA within 6 months of starting therapy (n/N [%])** 18/21 (87.5) 184/246 (74.8) 391/571 (68.1) 30/43 (69.8) Failure to achieve DAPSA ≤14 within 6 months of starting therapy (n/N [%])** N/A 74/110 (67.3) 201/365 (55.1) 3/3 (100.0) *Patients may be taking &gt;1 advanced therapy, **Not all patients had assessments of disease activity. Conclusion Preliminary data show approximately three quarters of Canadians with PsA failed to achieve MDA or LDA within 6 months of initiating an advanced therapy. Disease duration is a possible explanation for not achieving MDA or LDA; better therapeutic approaches are needed to achieve these outcomes in patients with PsA. Acknowledgements The authors wish to thank Dr. Steve Ramkissoon, for supporting the statistical analysis of the IPART registry. Medical writing and statistical support (funded by Abbvie) were provided by John Howell and Hong Chen, respectively, from McDougall Scientific. Financial support for the study was provided by AbbVie. AbbVie participated in the design of the study, interpretation of data, review, and approval of this publication. All authors contributed to the development of the publication and maintained control over the final content. Disclosure of Interests Denis Choquette Speakers bureau: Amgen, Abbvie, CIHR, Novartis, Pfizer, Fresenius-Kabi, Eli Lilly, Sandoz, Tevapharm, Consultant of: Amgen, Abbvie, CIHR, Novartis, Pfizer, Fresenius-Kabi, Eli Lilly, Sandoz, Tevapharm, Grant/research support from: Rhumadata is supported through grants and research contracts from Amgen, Abbvie, CIHR, Novartis, Pfizer, Fresenius-Kabi, Eli Lilly, Sandoz, Tevapharm., Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, UCB, Pfizer, Employee of: Spouse is an employee of AstraZeneca, Marie-Claude Laliberté Shareholder of: AbbVie Corp., Employee of: AbbVie Corp., Pierre-André Fournier Shareholder of: AbbVie Corp., Employee of: AbbVie Corp., Tanya Girard Shareholder of: AbbVie Corp., Employee of: AbbVie Corp., Mitchell Sutton: None declared, Dafna D Gladman Consultant of: AbbVie, Amgen, BMS, Galapagos, Gilead, Eli Lilly, Janssen Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB